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Cities to Take Lead in Enrolling Children in Health Coverage

The National League of Cities aims to help 20 cities enroll more children in Medicaid and the Children’s Health Insurance Program.

March 11, 2013

City officials will play a central role in enrolling more children in Medicaid and the Children’s Health Insurance Program (CHIP) when the National League of Cities (NLC) launches its Cities Expanding Children’s Access to Health Care initiative next week.

The three-year initiative, funded by a $3.25 million grant from The Atlantic Philanthropies, will take a tiered approach in assisting cities in reaching that goal. It’s a big goal that they’re striving for: According to federal estimates, roughly two-thirds of the country’s 7 million uninsured children are already eligible for Medicaid or CHIP. They just need to enroll.

So next week, NLC will release a request for proposals that will ask cities to outline their strategies for getting kids signed up for the state-federal programs that provide health coverage to low-income children. Twenty applicants will then be selected to attend Leadership Academies in July and September to further develop their plans.

Of those 20 cities, eight to 10 will receive planning grants of up to $30,000 to bring them closer to implementation. The planning phase is expected to last six months. Lastly, six cities will be awarded implementation grants worth up to $130,000 to put their plans into action over the first two years.

At NLC’s 2013 Congressional City Conference in Washington, D.C., Monday, NLC leaders and federal officials ticked off all the reasons that getting kids covered is important. Not having insurance leads to worse health, they said, which in turn leads to lower school attendance and academic achievement. A medical emergency can financially wreck low-income families. Cities also bear a financial burden to care for those kids, whether through operating free health clinics or paying hospitals and other health-care providers for uncompensated care.

“There are a lot of messages these days about health coverage for adults with the implementation of the Affordable Care Act,” said Donna Cohen Ross, senior policy advisor at the federal Center for Medicaid and CHIP Services, “but one of the things we always say is: Children don't have to wait. They can enroll today. We need everybody to roll up their sleeves and help.”

Another federal official painted a dire picture. Uninsured children are less likely to have a regular place to receive health care, said Caya Lewis, counselor for science and public health to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius. They’re more likely to postpone seeking health care because of its costs. One in seven low-income children is obese, she said, and are therefore at a greater risk of associated chronic conditions like diabetes and heart disease.

“We’re in danger of becoming a nation where this generation of children is going to die younger than their parents’ generation,” Lewis said.

So what can city officials do to enroll more children in health coverage and stem that tide? NLC leaders suggested a broad range of activities. The mayor and others can become public spokespersons and highlight the initiative in speeches and other events. Public television and billboards can be harnessed as outreach tools. The school district could identify uninsured children when they enroll in school and then connect them with the public health sector.

Officials can also work with the local chamber of commerce to encourage businesses to provide information to their low-wage workers. They can convene a task force with a broad range of stakeholders (everybody from police and fire departments to hospitals and health centers) to design a strategic plan to reach their target audience.

HHS has already launched its own campaign to reach low-income families in big media markets with a high number of uninsured children, Ross said, in states like California, Ohio and Texas. City leaders can feel free to tap their federal peers for advice or even draft promotional materials. They’ve made progress: according to federal estimates, the number of eligible but unenrolled children dropped from 4.8 million in 2009 to 4.3 million in 2011, even though 3 more million children become eligible for Medicaid or CHIP during the recession.

But that still leaves a lot of children to reach, Ross said, and city officials are uniquely positioned to get the message out.

“We have children who are eligible for benefits that they aren't receiving,” she said. “Let's get them signed up.”

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